• Todd C Lee, Goodwin WilsonMarnieMDivision of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada., Alexander Lawandi, and Emily G McDonald.
• Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Department of Medicine, Research Institute, McGill University Health Centre, Montréal, Québec, Canada. Electronic address: todd.lee@mcgill.ca.
• Am. J. Med. 2021 Mar 1; 134 (3): e184-e188.

BackgroundUpper gastrointestinal bleeding is common among the critically ill. Recently, the Proton Pump Inhibitors (PPIs) vs. Histamine-2 Receptor Blockers for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial suggested PPIs might increase mortality. We performed an updated meta-analysis to further inform discussion.MethodsWe leveraged 2 recent systematic reviews to identify randomized controlled trials directly comparing PPIs and H-2 Receptor Antagonists (H2RAs) for stress ulcer prophylaxis in critically ill patients and reporting mortality. We extracted mortality data from each study and meta-analyzed them with the PEPTIC trial using a random effects model.ResultsOf 28,559 total patients, 14,436 (50.5%) were allocated to PPI and 14,123 to H2RAs (49.5%). Compared to H2RAs, the pooled relative risk for mortality was 1.05 (95% confidence interval 1.00-1.10) with an estimated risk difference for mortality of 9 additional deaths per 1000 patients exposed to PPI (95% confidence interval 0-18); heterogeneity was low (I2 = 0%; P = 0.826).ConclusionsStress ulcer prophylaxis with PPIs likely increases mortality compared to H2RAs. Whether stress ulcer prophylaxis is beneficial in critical care remains open to further study.Copyright © 2020 Elsevier Inc. All rights reserved.

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